Beth Sandy on Incorporating Amivantamab and Mobocertinib into Clinical Practice for Patients With EGFR Exon 20 Insertion NSCLC

For patients with non–small cell lung cancer with exon 20 insertion mutations, the 2 approved agents for this population each have advantages and disadvantages, says Beth Sandy, MSN, CRNP.

Sandy, who is a thoracic oncology nurse practitioner at the University of Pennsylvania Abramson Cancer Center, recently presented an overview of the status of molecular testing and targeted therapies in lung cancer at the 6th Annual School of Nursing Oncology meeting. In an interview with Oncology Nursing News®, Sandy discusses important prescribing considerations with 2 novel drugs and how they are being incorporated into the treatment landscape.

“Most of us are familiar with the classic EGFR mutations, which are deletion 19 and exon 21-point mutations [and] we have drugs [such as] osimertinib (Tagrisso) or erlotonib (Tarceva) and these work very well,” Sandy says. “But there is a lesser-known EGFR mutation called exon 20 insertion, and it’s typically resistant to [the] classic EGFR inhibitors that we have.”

“[Two] new drugs were just approved in the past year: one is called amivantamab (Rybrevent) and one is mobocertinib (Exkivity). They’re very different drugs.”

Amivantamab, is a monoclonal antibody and is administered intravenously (IV), Sandy notes. The typical adverse effects include infusion-related reaction, and this tends to happen on the first treatment, she says. Most of these reactions are mild, and patients can be rechallenged once they are resolved. In addition, many patients who received amivantamab may also experience an acne-like rash.

“It’s not like paclitaxel where you [may] need to give an EPI-pen,” she says. ‘I’ve never had to do that with this treatment.”

Mobocertinib, on the other hand, is an oral agent that is taken daily as 4 tablets.

“There is 1 major adverse effect, diarrhea, and almost [every individual on mobocertinib] gets diarrhea. It’s a really high rate of diarrhea,” Sandy says.

Her advice? “Tell patients to have the [loperamide] on hand,” she says. “You may sometimes have to dose reduce; It’s 4 pills [daily, but] even just going down to 3 [can make a difference].”

Sandy concludes by noting that there are advantages to both treatments and that the drugs can also be sequenced in this setting.

Moving forward, she would like to see more data about the role these drugs may play in inducing pneumonitis, as this is something she has noticed in her own practice.